House Democrats scored a historic victory in the century-long battle to reform the nation's health-care system late Sunday night, winning final approval of legislation that expands coverage to 32 million people and attempts to contain spiraling costs.

The House voted 219 to 212 to approve the measure, with every Republican voting no. The measure now awaits President Obama's signature. In remarks Sunday night, he said that the vote "proved that we are still capable of doing big things. We proved that this government -- a government of the people and by the people -- still works for the people."

"Today we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans as a right, not a privilege," Pelosi said before the House approved the bill, which first passed the Senate on Christmas Eve.

The debate has consumed Obama's first year in office, with his focus on the issue amid a deep recession and crippling job losses potentially endangering his reelection prospects and Democratic majorities in the House and the Senate. It has inflamed the partisanship that Obama pledged to tame when he campaigned for the White House and has limited Congress's ability to pass any other major legislation, at least until after the midterm elections in November.

And it has sparked a citizens' revolt that reached the doors of the Capitol this weekend.

"If we pass this bill, there will be no turning back," House Minority Leader John A. Boehner (R-Ohio) warned on the floor. "In a democracy, you can only ignore the will of the people for so long and get away with it."

The bill will affect virtually every man, woman and child in the United States in some way, from the 20-somethings who constitute one of the largest uninsured groups to poor, childless adults who don't qualify for Medicaid in most states to well-paid professionals who could see their benefits shrink. The health-care debate touched on many highly charged moral issues in American life, and a handful of antiabortion Democrats held up a final deal until late Sunday afternoon, before reaching a breakthrough with the White House.

Along with the Senate's blueprint for reform, the House late Sunday approved a package of fixes to the legislation that will face a potentially rocky journey through the Senate this week. Over the next 10 years, the measure will set in motion a complex series of changes to the health insurance market that will translate into the biggest expansion of coverage since Medicare and Medicaid were created in 1965, and the most ambitious effort ever to restrain health-care costs.

Presidents as far back as Theodore Roosevelt have rued the nation's approach to health coverage, a system that serves relatively well the 150 million Americans who receive health insurance through their jobs but provides few affordable options for people who work part time, are self employed or work for companies that don't offer health benefits.

Obama conveyed to the wavering House Democrats who visited the White House in recent days that he had put his presidency at risk by pushing the House to act on the Senate bill. Although many House Democrats found the Senate legislation lacking, passing it was the only option after Republican Scott Brown won a Massachusetts special Senate election in January and cost Democrats their filibuster-proof majority in that chamber.

The 34 Democratic defectors were fewer than the 39 who voted against the House version approved in November, but the number was substantial enough to underscore the political uncertainty for many Democrats, especially those who represent moderate to conservative districts.